Healthcare Provider Details

I. General information

NPI: 1164019998
Provider Name (Legal Business Name): BRICELAND-KOLP & WILLMANN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 RIDGE MILL DR
HILLIARD OH
43026-7450
US

IV. Provider business mailing address

3734 RIDGE MILL DR
HILLIARD OH
43026-7450
US

V. Phone/Fax

Practice location:
  • Phone: 614-850-0446
  • Fax: 614-850-0446
Mailing address:
  • Phone: 614-850-0446
  • Fax: 614-850-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LISA BRICELAND-KOLP
Title or Position: OWNER
Credential: DDS
Phone: 614-850-0446